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Clinical Features Associated With ADB-BUTINACA Exposure In Patients Attending Emergency Departments In England: Difference between revisions

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Tremors were observed in mice 30 minutes following 1 mg/kg AMB-FUBINACA in the present study. Pretreatment times and dose ranges for the drug discrimination assay were selected based on the time of peak depression in the locomotor activity assay in mice. Average potency of the discriminative stimulus effects of early compounds was 0.81±0.17 mg/kg (Gatch et al., 2014), whereas the potency of a recent set was 0.09±0.03 mg/kg (Gatch et al., 2018), and the potency of the current set is 0.05±0.01 mg/kg. Short-onset, short-acting compounds have a greater abuse liability, and long-acting compounds pose problems of long-acting adverse effects and interactions with other drugs. The duration of action of the synthetic cannabinoids tested using the 8-h protocol have varied widely, with some producing a duration of action no longer than 1 h, others producing a duration of action between 1–2 h, and others lasting more than 2 h. There seems to be a trend of newer synthetic cannabinoids being more potent than earlier compound<br><br><br>Separation of compounds was performed on a 2.1 mm×100 mm, 1.7 adb butinaca μm particle size ACQUITY Torus™ DIOL analytical column (Waters) with guard cartridge. Measurements were performed by an ACQUITY UPC2 supercritical fluid chromatography system (Waters) coupled with a Xevo TQ-S Triple Quadrupole Mass Spectrometer (Waters). During the death scene examination, multiple cigarette butts without filters were found in an ashtray; also found were alcohol bottles, an unopened box of nebivolol-containing drug, and 18 g of unrecognizable herbal residue in a cigarette box.<br>Data concerning the combined effects of SCRAs and other substances are highly limited, which renders forensic evaluation of possible overdose cases difficult . The threshold SCRA concentration for fatal overdose can be estimated ng/mL level (0.37–4.1 ng/mL according to the reported cases) in cases in which 1.5–2.5 g/L of ethanol is present in the blood. The victims were brothers who were both found deceased after consuming 4F-MDMB-BINACA and ethanol. These confusing shorter names were not scientifically adopted but were used by websites selling the drugs to the public. Monitoring metabolism of synthetic cannabinoid 4F-MDMB-BINACA via high-resolution mass spectrometry assessed in cultured hepatoma cell line, fungus, liver microsomes and confirmed using urine samples. This article does not contain any studies with human participants or animals performed by any of the author<br><br><br>In general, the locomotor depressant and discriminative stimulus effects [https://cannabinoidsrc4f-adb.com/ adb butinaca] have been observed at doses that do not produce adverse effects, although tremors were observed upon handling in mice that received JWH-210 (Gatch et al., 2016), and 5F-AMB produced sustained vocalization and convulsions in rats (Gatch et al., 2018). All of the synthetic cannabinoids tested in the present study fully substituted for the discriminative stimulus effects of Δ9-THC. Subsequently, a one-way analysis of variance was conducted on horizontal activity counts for the 30-min period of maximal effect, and planned comparisons were conducted for each dose against the vehicle control using single degree-of-freedom F tests. A two-way analysis of variance, with dose as a between groups factor and time as a within subject factor, was conducted on horizontal activity counts/10 min interval.<br>Michael B Gatch <br>These findings are in agreement with earlier studies showing the synthetic cannabinoids substitute for the discriminative stimulus effects of Δ9-THC (see review by Wiley et al., 2017). Pretreatment times and dose ranges for the drug discrimination assay were selected based on the time of peak depression in the locomotor activity assay in mice. As mentioned previously, short-onset compounds have a greater abuse liability; further, compounds that have fewer adverse effects while they are active are likely to be preferred. All five of the compounds in the present study fully substituted with a pretreatment time of 15 min, suggesting a rapid onset of the discriminative stimulus effects. All of the cathinones fully substituted for the discriminative stimulus effects of Δ9-tetrahydrocannabinol (≥80% drug-appropriate responding). Because response suppression may compromise stimulus control, rats failing to complete at least ten responses during the test session were excluded from the analysis of the discriminative stimulus effects of that dose of test compoun<br><br><br>Similarly, precursor ion identified at m/z 380 (B19/B21, B23/B25) was 16 Da higher than the 4F-MDMB-BINACA, indicating monohydroxylation at the butyl side chain (B19/B21) and indazole (B23/B25) moieties with product ions m/z 145 and 161, respectively. Metabolites identified at m/z 366 (B8, B9, B13), which was 16 Da higher than the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), confirmed monohydroxylation upon ester hydrolysis. Death involving these drugs have been reported [5,6,7,8,9], and this raises public health and social concerns. Due to their similar physiological effects to the principal psychoactive component of cannabis, Δ9-tetrahydrocannabinol (THC), SCBs are gaining popularity and are often abused as recreational drugs. The fact that similar 4F-MDMB-BINACA and ethanol concentrations were detected in the postmortem blood samples of both victims suggests that both substances played a role in the fatal outcom
LC-QTOF-MS represents a significant advancement in the field of drug detection, offering higher sensitivity, specificity, and a broader spectrum of detectable substances. Despite all negative results in the point-of-care test for recreational drugs, the liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analysis showed that the liquid of the e-cigarette contained ADB-BUTINACA, a synthetic cannabinoid. We report a 27-year-old man who was admitted to the emergency room because of sudden [https://cannabinoidsrc4f-adb.com/ homesite] headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly available.<br>Data availability <br>When clinical presentation and/or initial DOA testing results are inconclusive, additional testing with LC-QTOF-MS can be valuable and is recommended. SCRAs and other NPS may not be detected by point-of-care DOA tests. In this case, the point-of-care DOA urine screening was not able to detect the synthetic cannabinoid ADB-BUTINAC<br><br>The % peak area abundance ratio of metabolites detected in the urine samples are often affected by numerous factors such as drug intake behaviour (intake route, amount of drug and intake frequency), time from last drug intake and metabolic stabilit<br><br><br>Taken together these data further confirmed the structure elucidation of B16. The precursor ion m/z 276 (B1) detected, which was 74 Da lower than that for the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicated N-dealkylation of B22. The precursor ion m/z 348 and product ion detected at m/z 217 (B2) identified was 2 Da less than the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicating oxidative defluorination (loss of fluorine with addition of hydroxy homesite group<br><br><br>Although there were reports on the metabolism of 4F-MDMB-BINACA using in-vivo and various in-vitro models, studies were either conducted using small in-vivo sample size such as 1 to 4 samples [5, 29] or in closed environments such as forensic psychiatric wards and prisons . The hepatic cell line HepG2 is often used as an initial screen as it is known to produce high reproducibility results with relatively stable enzyme concentration, although they are limited by the low-level expression of several metabolizing enzymes, including the cytochrome P450 (CYP) class of proteins [17, 18]. In-vitro metabolism studies are generally used to complement these data using perfused organs, tissue or cell cultures and microsomal preparations amongst which pooled human liver microsomes (HLM) have been frequently used to elucidate metabolism of SCBs [12,13,14,15,16]. Since most SCBs are found extensively in metabolized forms in urine, the identification of metabolites is of vital importance for forensic and clinical toxicologists. Identifying SCB intake and its correlating specific adverse effects require rapid elucidation of these SCBs. The proliferation of SCBs has become a global challenge as new compounds are rapidly introduced into the illegal drug market to evade existing drug law<br><br><br>§ (3) of the Hungarian act of Forensic Experts (2016.XXIX), the data of the reported case can be utilized freely for scientific and educational purposes without special ethical permission. These results indicate that the simultaneous intoxication of SCRA and ethanol directly and exclusively caused the death of the two victims. The victims did not have any significant diseases that could have contributed to the outcome. Very limited data are available in the scientific literature about the possible effects of the combined consumption of SCRAs and ethanol. Several case reports describe that the presence of a little ng/mL (0.37–4.1) of SCRAs and a high—but not lethal—concentration of ethanol (1.45–2.7 g/L) directly and exclusively contributed to the death of the victim [24–27] (Table 2). The fact that 4F-MDMB-BINACA was not detected in postmortem urine samples is partly explained by the high rate of hepatic metabolism of SCRAs [11, 14, 22], but also suggests that the victims consumed 4F-MDMB-BINACA shortly before their death<br><br><br>Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.<br>Fig. 2. <br>The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.<br>Fig. 1. <br>This outcome was anticipated since CES-mediated hydrolysis is commonly homesite reported as the major metabolic pathway among the SCBs impacting the terminal ester group . Glucosides and sulfate metabolites have been reported with other SCBs where C. From these three samples, sample 2 contained only an ester hydrolysis metabolite (m/z 350). Both ester hydrolysis followed by oxidative defluorination to butanoic acid (B4, m/z 362) and monohydroxylation at tert-leucine moiety (B8, m/z 366) metabolites were found in 16/20 urine samples (Table 2). A In-vitro metabolites observed in common among respective seven most abundant metabolites in b C. The product ion detected at m/z 235, indicating loss of sulfate, confirmed the identity of the sulfation metabolite.<br>Fungus C. elegans <br>Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect

Latest revision as of 09:49, 24 May 2026

LC-QTOF-MS represents a significant advancement in the field of drug detection, offering higher sensitivity, specificity, and a broader spectrum of detectable substances. Despite all negative results in the point-of-care test for recreational drugs, the liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analysis showed that the liquid of the e-cigarette contained ADB-BUTINACA, a synthetic cannabinoid. We report a 27-year-old man who was admitted to the emergency room because of sudden homesite headache, nausea, vertigo, red eyes and palpitations. Synthetic cannabinoids are gaining popularity globally and detection is not commonly available.
Data availability
When clinical presentation and/or initial DOA testing results are inconclusive, additional testing with LC-QTOF-MS can be valuable and is recommended. SCRAs and other NPS may not be detected by point-of-care DOA tests. In this case, the point-of-care DOA urine screening was not able to detect the synthetic cannabinoid ADB-BUTINAC

The % peak area abundance ratio of metabolites detected in the urine samples are often affected by numerous factors such as drug intake behaviour (intake route, amount of drug and intake frequency), time from last drug intake and metabolic stabilit


Taken together these data further confirmed the structure elucidation of B16. The precursor ion m/z 276 (B1) detected, which was 74 Da lower than that for the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicated N-dealkylation of B22. The precursor ion m/z 348 and product ion detected at m/z 217 (B2) identified was 2 Da less than the 4F-MDMB-BINACA ester hydrolysis metabolite (B22), indicating oxidative defluorination (loss of fluorine with addition of hydroxy homesite group


Although there were reports on the metabolism of 4F-MDMB-BINACA using in-vivo and various in-vitro models, studies were either conducted using small in-vivo sample size such as 1 to 4 samples [5, 29] or in closed environments such as forensic psychiatric wards and prisons . The hepatic cell line HepG2 is often used as an initial screen as it is known to produce high reproducibility results with relatively stable enzyme concentration, although they are limited by the low-level expression of several metabolizing enzymes, including the cytochrome P450 (CYP) class of proteins [17, 18]. In-vitro metabolism studies are generally used to complement these data using perfused organs, tissue or cell cultures and microsomal preparations amongst which pooled human liver microsomes (HLM) have been frequently used to elucidate metabolism of SCBs [12,13,14,15,16]. Since most SCBs are found extensively in metabolized forms in urine, the identification of metabolites is of vital importance for forensic and clinical toxicologists. Identifying SCB intake and its correlating specific adverse effects require rapid elucidation of these SCBs. The proliferation of SCBs has become a global challenge as new compounds are rapidly introduced into the illegal drug market to evade existing drug law


§ (3) of the Hungarian act of Forensic Experts (2016.XXIX), the data of the reported case can be utilized freely for scientific and educational purposes without special ethical permission. These results indicate that the simultaneous intoxication of SCRA and ethanol directly and exclusively caused the death of the two victims. The victims did not have any significant diseases that could have contributed to the outcome. Very limited data are available in the scientific literature about the possible effects of the combined consumption of SCRAs and ethanol. Several case reports describe that the presence of a little ng/mL (0.37–4.1) of SCRAs and a high—but not lethal—concentration of ethanol (1.45–2.7 g/L) directly and exclusively contributed to the death of the victim [24–27] (Table 2). The fact that 4F-MDMB-BINACA was not detected in postmortem urine samples is partly explained by the high rate of hepatic metabolism of SCRAs [11, 14, 22], but also suggests that the victims consumed 4F-MDMB-BINACA shortly before their death


Due to the unknown toxicity of newly emerging SCRAs, forensic assessments of cases involving these substances are challenging. According to the reported cases and reviews of the scientific literature, concurrent ethanol consumption should amplify the toxicity of SCRAs. The concentration of 4F-MDMB-BINACA in the postmortem blood was 2.50 and 2.34 ng/mL, and blood alcohol concentration was 2.11 and 2.49 g/L, respectively. Two fatal cases are reported caused by simultaneous consumption of 4F-MDMB-BINACA and ethanol.
Fig. 2.
The precursor ion m/z 396 (B10, B12/B15) was 32 Da higher than the parent drug, 4F-MDMB-BINACA, suggesting the addition of two hydroxy groups. All the below explanations for transformations into metabolites are based on the data shown in Fig. Metabolites were identified according to their precursor ions, product ions, and fragmentation patterns (Fig. 1). Traditional in-vivo metabolism studies to generate human metabolites of drugs relied heavily on the use of whole animal model systems, which are expensive, limited by drug administration amount, influenced by species variation and faced by many ethical issues. Eight in-vivo metabolites tentatively identified were mainly products of ester hydrolysis with or without additional dehydrogenation, N-dealkylation, monohydroxylation and oxidative defluorination with further oxidation to butanoic acid.
Fig. 1.
This outcome was anticipated since CES-mediated hydrolysis is commonly homesite reported as the major metabolic pathway among the SCBs impacting the terminal ester group . Glucosides and sulfate metabolites have been reported with other SCBs where C. From these three samples, sample 2 contained only an ester hydrolysis metabolite (m/z 350). Both ester hydrolysis followed by oxidative defluorination to butanoic acid (B4, m/z 362) and monohydroxylation at tert-leucine moiety (B8, m/z 366) metabolites were found in 16/20 urine samples (Table 2). A In-vitro metabolites observed in common among respective seven most abundant metabolites in b C. The product ion detected at m/z 235, indicating loss of sulfate, confirmed the identity of the sulfation metabolite.
Fungus C. elegans
Methyl (2S)-2-([1-(4-fluorobutyl)-1H-indazole-3-carbonyl]amino)-3,3-dimethylbutanoate (4F-MDMB-BINACA, 4F-MDMB-BUTINACA or 4F-ADB), found in numerous SCB product seizures, has been reported by various law enforcement since 2018 . However, most of the SCBs are full agonists at CB1 and CB2 receptors, having a higher risk of undesirable side effects when compared to THC which is a partial agonist . Synthetic cannabinoids (SCBs) are agonists at cannabinoid receptor type 1 (CB1) and type 2 (CB2), where they elicit their main effect